Loving kids the wrong way

Being sexually attracted to children isn’t sick, just acting on it. That’s the idea behind a groundbreaking paedophilia therapy programme at Charité. Time to reevaluate one of our society’s greatest taboos?

Most paedophiles have never touched a child, and never will. Which is a relief when you realise that they might account for at least one percent of the male population. Some of them are seriously struggling with their sexuality, though, and they need help. That’s what the team at Charité’s project “Kein Täter werden” (“Don’t offend”) has been offering to thousands of men since 2005, under the premise that paedophilia might be a sexual orientation like homosexuality or heterosexuality. Their mantra: “You’re not guilty because of your sexual desire, but responsible for your sexual behaviour.” Hannes Gieseler is a sex therapist who’s been involved with the programme for three years. We met at a location the team requested we kept confidential for a dispassionate chat about paedophilia and how acceptance of those affected might be the best way to keep children safe.

Who are the people who come to you?

They are people who are attracted to children and feel that their sexual behaviour is problematic – because they use child pornography, or they’ve been in contact with children and had inappropriate behaviour towards them, and/or feel they might abuse them. They get in touch through the hotline or by email, or they’re sent to us by therapists or doctors. More than 2400 people have contacted our Berlin centre since 2005; 7000 if you look at the whole prevention network.

What are the criteria for being taken in the programme?

We invite them to a two-hour clinical interview in which we explore their sexual history, their behaviour, their fantasies, etc. We establish a diagnosis, and we decide if they fit the programme. Basically, we take paedophiles and hebephiles, patients attracted to prepubescent or pubescent boys and girls. The criterion here is not age, but the physical development of the human body. If you’re attracted to boys or girls before puberty, it’s paedophilia. As soon as puberty starts, it’s hebephilia – the latter accounts for less than 40 percent of paedophiles. All in all, some 500 interviewees have been invited to take part in therapy in Berlin.

Depending on studies, one to nine percent of men have sexual fantasies involving kids.

Who are the ones you turn down?

People with other major addiction or psychiatric diagnoses. Also, they shouldn’t be involved in a pending legal case. We’re not including prosecuted offenders unless their case is closed. The idea is that this could be their motivation to come to therapy – to influence their case.

So, as we speak, how many people are following your therapy here at Charité?

We’re currently seeing around 57 men, with 30 coming in on a weekly basis, mostly for group therapy.

They’re all men?

Yes. Paedophilia among women is very rare. We’ve had no more than 20 come to us over the years, and only one was diagnosed with paedophilia. It’s the same with sex offenders in jail – studies show that most are men.

How do you explain that?

We don’t explain it – we just observe it. It applies to all paraphilias, sexual orientations that don’t lead to procreation – what they used to call “perversions”, from exhibitionism to masochism to fetishes. We know they’re more common with men than women, but we don’t know why.

It’s been reported that over one percent of men are paedophiles – sounds like a lot!

Depending on studies, one to nine percent of men have sexual fantasies involving kids. But paedophilia is really hard to diagnose, especially because it doesn’t have to be exclusive. Some paedophiles are able to sexually engage with adults as well; 40 percent of men in our programme have a partner, over 30 percent have a family. We lack proper systematic data, but one percent seems to be approximately right.

But where do you draw the line?

Literature, for example, is full of characters being attracted to the pure, virginal beauty of a little boy or girl. Thomas Mann’s infatuation for the young Tadzio on a Venice beach... does it make him a paedophile? There’s nothing wrong or abnormal with being sensitive to a kid’s beauty... But once you get aroused by that child, and the memory of that child induces an orgasm during masturbation, then you have crossed the line. Artistic depictions of those fantasies are a grey area, though: whether you draw or paint kids or write novels, you’ve got to be careful not to slip into the illegal realm of child pornography.

Can you ‘profile’ a typical paedophile?

No. The paedophiles we’ve observed in the Berlin programme come from all kinds of social and cultural backgrounds and their ages range from 17 to 70, the average being about 37 years old. Most of them have jobs. Because of their sexual inclination, many of them are lonely; about half never married and don’t have a family. But many others are perfectly successful, happy-looking people. You wouldn’t expect them to be paedophiles if you saw them at your workplace or on the street. They are like you or me.

Many paedophile scandals have involved teachers or child carers – are there more of them in such jobs?

Maybe a bigger proportion, but not so big. But you won’t develop paedophilia from working with kids. It’s there before, and unconsciously, some might be attracted to jobs involving kids.

What about priests?Catholic Church scandals have been linked to repression coming from celibacy, does that make sense?

No, it’s the same. You won’t develop paedophilia because you took a vow of celibacy. It might be that unconsciously or not, they chose this way of life because it made it easier to deal with their preexisting sexuality... but then it catches up with them.

What about the relation between incest and paedophilia? Do all paedophiles molest their own kids?

No, there’s what we call the incest Schranke [barrier]: some paedophiles who are dads are just not interested in their own kids.

This begs the questions: what’s the sexual attraction to kids all about? How do your patients talk about it?

It is very individual. Just as a hetero man is not attracted to every woman, someone attracted to kids is not attracted to all kids. It might have to do with a given child’s personality, their skin, the way they move. For some, it’s just the point puberty hits – that particular budding moment when breasts start growing, pubic hair starts developing. But the realm of sexual fantasies is infinite. You hear some weird things!

Do you have an example?

One man’s fantasy was to be shrunk to about 5cm and then be swallowed alive by a child – in this case, the gender didn’t matter so much – and hang out in their inner organs. This was his favourite sexual fantasy, but he had others, like a fetish for kids’ feet. But all his fantasies involved children.

Is this disease, a pathological disorder? Are paedophiles sick?

It becomes a disorder when the person with this sexual interest is suffering – or someone else is suffering. If you abuse a child, then it is a disorder.

Are you saying the pathological and legal definitions of paedophila totally coincide?

One major difference is that the law makes decisions by age – no pornographic images under age 18, no sex under 16 without parental consent – while we work by bodily age. For us, someone attracted to a 13-year-old with a fully developed woman’s body isn’t a paedophile.

So what about child pornography?

It’s a bit of a grey area, especially online. Looking at pictures of clothed kids in appropriate settings is totally legal. The problem starts as they get undressed. It becomes a crime with the explicit depiction of genitals and/or erotic poses, up till pictures of obscenity or violence. Many paedophiles use underwear catalogues or beach holiday pictures to get aroused, and this is still legal. But we might consider it problematic – for example, we’d ask them to tell us what they think the children in the pictures would think...

Can you explain where paedophilia comes from?

We don’t know. Sexual preferences are as varied as fingerprints. It’s just amazing what can be sexually arousing for a particular individual – anything goes. To be honest, we don’t know where sexual orientation in general comes from. Why is someone heterosexual or homosexual? We don’t know. What we know is that is seems to start with puberty. That’s what most patients say. Whereas most teenagers start fantasizing about adults or same-age kids, they’d have fantasies about younger kids. Of course, it might come to the surface later. That’s why we now have a dedicated teenage programme for kids 12-18.

To refer to paedophilia as a ‘sexual orientation’ – this is a huge taboo you’re challenging here. Most people still associate it with child-abusing monsters...

Yes, there are many misconceptions out there. Not all child molesters are paedophiles – that’s simply not true, at least for 50 percent of them. We know from prison studies that many often have other problems, like personality disorders. And only a minority of paedophiles abuse children. Among those who come to us, it’s about 43 percent, but these have already reached a stage where they need help. We consider paedophilia to be a ‘risk factor’ like smoking for heart disease... But a man can be aroused by children without ever acting on his sexual desire.

Your job is to lower the risk factor, right? How do you help paedophiles not become offenders?

We help them control their behaviour – learn how to control their sexual urges, regulate their emotions. For that we have group therapy, but also medication – a testosterone inhibitor, for example, will suppress fantasies, masturbation and hypersexuality problems. But it’s got to be in combination with therapy, and it has to be their choice. If they come to us, they want to quit their problematic sexual behaviour.

You said “quit”, not “cure” – can you cure paedophilia?

If you consider the behaviour to be the pathology, then you can cure it. As far as we know there’s no cure for the sexual interest.

Is that where the suffering comes from, because it’s so difficult to satisfy their sexual desire without breaking the law? Or is it the shame?

Well, it’s not easy to find a relationship – maybe you’ll be lonely all your life. Then of course there’s the stigma. Most of them feel ashamed. They didn’t choose to be paedophiles, and they don’t want it.

Is it like AA, where meeting with others sharing the same problem helps people open up?

Yes, they do support each other, a bit like with AA. They might say: “I quit using online child porn” and get a lot of support from the group over weeks of “abstention”. And it is also a sheltered environment. For many, coming here is a big step – so we protect their anonymity.

Anonymity is one thing. What about impunity?If they tell you they did something illegal, you won’t report them, right?

As medical staff in Germany, it’s our duty to protect the privacy of our patients. We don’t have the mandatory reporting laws that they have in the US or UK, that obligate doctors to report paedophiles who have offended, are offending or even might offend in the future but haven’t yet.

What if one of your patients is currently abusing a child?

If someone tells us they are abusing a child and will again as soon as they leave the session, we will of course take action – hospitalise them in a psychiatric ward, for example. But it would always have to include the patient. In one case we had a man abusing a child in his close surroundings, and he decided to take medication. But if there were no other option, we’d report them to the authorities, of course.

What do you tell people who think offenders like him shouldn’t be helped, just locked up?

Jail is no cure. We know from surveys that unless they get help – therapy or medication – they re-offend. Another point is the huge proportion of undetected offences, what we call the “dark field”: most cases of child abuse are not prosecuted; only one percent are, according to a recent Australian study. So once you realise that, you might reevaluate the importance of what we do.

How do you assess a successful therapy?

Last year, we invited former participants for follow-up interviews, and most said that they now live a happy everyday life compared to before – they’re more aware and more comfortable with their sexual interest. No more suppressed sexuality. They know what can happen, and they control it better.

Twelve years ago, when you started, it sparked real uproar. You’re now financed by the Berlin Senat and a new law will guarantee the treatment is covered by health insurance...

It’s been a long path, but now politicians are totally on board and pushing forward. What we do, on this scale, is very unique. Many countries envy us.

You requested that we don’t disclose your exact location. Do you still feel misunderstood among the public?

For some people, it is difficult to comprehend that paedophilia can be considered a sexual orientation and that sexual interest in children does not automatically lead to sexual offence. People need to understand: paedophiles are no monsters – just people like you and me whom we need to help as the best way to keep children safe.

When you go to a party and you’re asked what you do... what’s the reaction?

I simply say that my job is to prevent child sexual abuse. Once you know how to explain it, people are very open and supportive. Or maybe I go to the wrong parties!

Do you have kids?

Yes, and actually, all this knowledge – about how it happens, why it happens, how it works – makes me feel much safer for them.

I guess you don’t put photos of them on Facebook, though...?

No, I certainly don’t!

Hannes Gieseler is a 39-year-old sex therapist. Born in Dresden, he first studied design in Dessau before graduating as a medical doctor at Berlin’s Charité University. For three years now, he’s been working at the Berlin site of Kein Täter werden, where he oversees diagnosis, group therapy and drug treatment (when appropriate) for the 57 patients who are currently in the programme.

“Don’t offend”

Initiated in Berlin in 2005 by Professor Klaus M. Beier as “Präventionsprojekt Dunkelfeld” (“prevention project dark field”), Charité’s child abuse prevention programme has since developed into the nationwide network “Kein Täter werden”, with 11 locations spread across Germany. As of September 2016, the Berlin site has provided anonymous consulting services and psychological support to about 990 men from all over the country, with 117 successfully completing therapy. Currently, 57 patients are in the Berlin programme. The taboo-breaking project faced controversy at its beginnings but slowly gained acceptance, at least among politicians. At first sponsored by the Volkswagen Foundation, the Charité centre is now fully funded by the city of Berlin; beginning this year, health insurance will be legally required to cover the treatment.